Does Medicare Cover Long-Term Nursing Home Care?

In addition to regular health insurance, long-term care insurance, or LTC insurance, is worth considering as part of senior care, whether for yourself or your parents.When you need this type of insurance, it can be too late to get it, so it is critical to consider it in advance when planning for the future. This guide answers the question, What is long-term care insurance? and provides more information for your planning process. Table of Contents: What is Long-term Care (LTC) Insurance?How Does Long-Term Care Insurance Work?Who May Need LTC Insurance?Who May Not Need LTC Insurance?How Do You Qualify for Long-Term Care Insurance?Benefits of Long-Term Care InsuranceWhere to Find LTC Insurance?LTC AlternativesWhat Is Long-Term Care (LTC) Insurance?Generally, regular health insurance plans do not cover long-term care services. This is where long-term care or LTC insurance comes in. It can cover services that help you with activities of daily living (ADLs), like assistance with showering and eating.This insurance helps cover personal and custodial services whether you or your loved one still lives at home or has moved to a community, such as a nursing home or assisted living community. It could also cover some services provided by a human services community organization.There are newer types of LTC insurance, including combination, hybrid, asset-based, and linked benefit options. It may be worth looking into your options and seeing whether a certain type could suit your needs and situation.How Does Long-Term Care Insurance Work?When you use care services that support activities of daily living, long-term care insurance coverage can pay you back a daily amount to cover some or all the costs of the services. The reimbursement amount depends on the pre-selected limit of your policy, like how you have certain limits and guidelines associated with a regular health insurance plan.Like other types of insurance, your coverage will vary by the insurance company you choose, the policy, and the terms of that policy. When you use the coverage, it will have maximum amounts for how many days/years it will cover and how much it will cover each day. There is also a lifetime maximum amount that reflects the two numbers together.Generally, your policy will have a waiting period. You must pay for the care up front, often for a waiting period of 30 to 90 days, and then the policy will reimburse you.Long-term care insurance often does not cover the costs of care indefinitely. Policies tend to have limits, including coverage for a limited number of years or the amount covered. Nonetheless, some policies cover long-term care costs for the rest of your life. It is essential to consider the type of plan and coverage when comparing providers. Be aware that policy premiums can increase over time.Who May Need LTC Insurance?Long-term insurance is beneficial for individuals who need to hire a professional to help with activities of daily living, such as bathing, going to the bathroom, getting dressed, and eating. When applying for LTC insurance, it is not enough to want this kind of support; you must show that you actually need it. This might be due to a chronic condition or an impairment that prevents you from being able to care for yourself.Some avoid long-term care policies because they think they are for living in a nursing home, and many people do not plan to live in one or hope to avoid it. However, you or your loved one can use LTC insurance to stay in your own home and receive extra assistance. LTC insurance can also help with other options if your family needs them, including assisted living, community services, or a nursing home if that indeed is something you end up needing even though you did not plan for it.Who May Not Need LTC Insurance?You may not benefit from this kind of insurance if you do not need professional assistance with activities of daily living. Maybe your parents can still do these activities independently, or they may have a spouses support to help them daily. Alternatively, there may be family members or friends who can help. In this case, your family may not need to hire anyone and, therefore, will not need long-term insurance to help cover costs.If your loved one does not have the conditions or diseases covered, they might not need or qualify for this insurance.How Do You Qualify for Long-Term Care Insurance?You cannot just get or use long-term care insurance. You must qualify to buy the initial plan and use its coverage.Qualifying for Long-Term Care InsuranceYou must get LTC insurance coverage when you are still healthy, so you must sign up before you need it. Ideally, you need to sign up when you are still healthy, active, and independent. If you need extra support in the home or need to move to a facility, it is often too late to get coverage. You may not qualify for long-term care insurance if you wait until you need it.You need medical underwriting to get one of these policies, so the state of health impacts whether you qualify. Policies even look at health history.The chance of being declined for LTC coverage is about 12.4 percent from ages 40 to 45 and 47.2 percent from ages 70 to 74. Further, most people wont get approved past age 75. Most people with long-term care insurance buy it in their mid-50s or mid-60s. If you can find a policy that covers you despite poor health or older age, it may be limited or cost more as the price is determined by your age when you sign up; the older you are when you first sign up for the policy, the more it will cost. Benefits of Long-Term Care InsuranceWhile long-term care insurance does not make sense for everyone, it provides numerous benefits to many people. Here are a few benefits to consider:Support for the FamilyThis insurance can help your family feel better about having your needs met as you age and have more difficulty caring for yourself. It can even take some of the burden of care away from your family members. Caring for an aging loved one can be difficult financially, physically, mentally, and in other ways. Hiring professional in-home care can reduce the burden on your family and ensure you have the right level of care you need, which may even help you have a better relationship.Increased OptionsThis kind of insurance generally gives you more options for the care you can receive. Without this insurance, you could be limited by your private finances or the restrictions of what Medicaid will cover. Having this coverage could open your options and even help you stay in your home, which many people want as they age.Tax BenefitsIn addition, having long-term care insurance can come with tax benefits. On your federal taxes and even some state taxes, you can include long-term care insurance premiums on your itemized deductions as medical expenses. Of course, this requires filing your taxes with itemized deductions and following other limitations. A tax professional can help you determine whether you could file these expenses as deductions, how much you can file, and whether it is beneficial to do so.Where to Find LTC InsuranceTalking with an estate planning or elder law attorney can help you and your family learn more about LTC insurance and how it fits into your planning.When you are ready to sign up for a plan, apply through an insurance company offering long-term care coverage. Like regular health insurance, you can look for policies through an employer, the insurance company, or an insurance broker or agent.As with other insurance, compare quotes and policies from different companies.  If applicable, you may be able to get a better group rate and easier qualification process through an employer, but it is worth comparing it to independent plans.After you apply, you go through an interview that covers your needs and personal information, such as health history and personal finance information. An insurance professional or company provides a custom policy to fit your unique situation.At this point, there is a medical underwriting process that includes contacting your physicians offices and reviewing their medical records. This part of the process can take weeks.LTC AlternativesHow else can you pay for support if you do not have long-term care insurance? If you are of age to qualify for Medicare, it can cover a portion of long-term care. Nonetheless, its coverage is extremely limited. Beyond that, you can pay for care out of pocket. Further, Medicaid is an option if you meet the qualifications, which can happen after people spend their savings on care.Medicaid vs LTC InsuranceYou may have heard that the government program Medicaid can help with the cost of long-term care, and that is true. Nonetheless, it has limits, as does long-term care insurance. What are the pros and cons of each type?To use Medicaid, you must meet financial requirements. These vary by state, but you must use your personal financial assets until they are spent down to a certain level. Medicaid will check how you used your assets over the previous 60 months, so you cannot give them away to others. Learn more about these limitations in your state and the amount a healthy spouse can keep in that state.You should also investigate whether your state has a partnership program. A partnership policy helps people use up their long-term care benefits and then switch to Medicaid coverage while keeping more of their assets. This kind of policy enables you to keep a higher amount of personal assets while using Medicaid to cover long-term care, as well as qualify for Medicaid sooner than you normally would have.Medicaid only provides coverage for certain skilled nursing care facilities and some community-based care options, such as an adult day care center. Long-term care insurance, on the other hand, tends to cover care in your own home or an assisted living facility. If you need a skilled nursing care facility, you will find more options available to you with long-term care insurance than with Medicaid.Find Support from CarePatrols Local Senior Care AdvisorsLong-term care insurance can help cover the cost of senior care, which is a critical component, but selecting the right senior care solution is equally important. CarePatrols Local Senior Care Advisor can help you determine the best senior care option for you when that time comes. Whether that means receiving home health care or transitioning to the support of assisted living, memory care, or a nursing home, our advisors will help you find the best option. Contact a CarePatrol Local Senior Care Advisor today to get started.

Caregiving for the Caregiver Have you had a chance to pick up the October issue of Real Simple magazine yet? If not, it's time you did! In fact, it's our CEO's favorite magazine read because it is all about how to make life just a little bit simpler. Dont we all need that! This month, there's a particular article that speaks directly to youthe caregivers. Now, some of us have been on this caregiving journey for years, while others may have recently embarked on this path. And if you arent a caregiver yourself, chances are you know someone who is. According to Real Simple, in 2020 alone, approximately 53 million Americans were caregivers. That number is set to grow, with projections suggesting that one in five of us could be caregivers by 2030. Its a humbling statistic that reminds us all of the broader support network we might one day be a part of. At Beneficent, we're currently immersed in a book called The Go-Giver. It's an inspiring read that highlights how givingin any formcan lead to business success and personal fulfillment. Without giving away too much, the book emphasizes creating more value for others than what you receive in return. For us, this means offering more than just our services to caregivers like you. We want to provide you with certainty and peace of mind, ensuring that your financial resources are sufficient to care for your loved ones, allowing you to finally take that long-deserved vacation. Whether you are a caregiver or you know someone who is, its important to remember to give a little care back to yourselves. Caregiving is an incredibly rewarding but often challenging role. It can sometimes feel isolating, physically demanding, and emotionally taxing. If you're a caregiver, remember to carve out time for yourself, even if its just a few precious moments each day. And for those of you who know a caregiver, think about ways you can support them. A small gesture, a listening ear, or some practical help can go a long way in easing their load. Ultimately, whether you're the caregiver or the one supporting them, remember that were all here to support each other in this community. Taking care of those who take care is a gift in itself.BeneficentWe provide trustworthy long-term care guidancefor deeply caring family members facing a critical long-term care financial crisis. We help clients understand, prepare, and qualify for programs covering high costs of Long-term Care including adult day care home care assisted living memory care nursing homes.

Congress recently made significant changes to Medicare's Part D prescription drug benefit as part of the Inflation Reduction Act. While some changes aim to help seniors afford their medications, others may have unintended consequences.On the positive side, insulin costs are now capped at $35 per month for Medicare beneficiaries. This has already provided relief for many seniors with diabetes.Starting in 2025, out-of-pocket Part D drug costs will be capped at $2,000 annually. Seniors will also have the option to spread these costs throughout the year through the new Medicare Prescription Payment Plan. These changes can benefit seniors who rely on multiple brand-name medicines or have fixed incomes.However, awareness of the new payment plan is low. Medicare could do more to inform seniors about this option, which requires opting in. Seniors should consider contacting their Part D insurers during open enrollment if they would benefit from spreading out pharmacy costs.The law's drug price negotiation provision has led to some unintended effects on drug development. At least 36 research programs and 22 experimental drugs have been discontinued as a result.Part D premiums have also increased. This year, standalone Part D plans were set to cost 21% more on average compared to last year. Many seniors switched to lower-cost options as a result. The number of available plans has decreased by about 25% since 2020.Some insurers have moved certain medications to tiers requiring higher out-of-pocket costs, restricting access to previously covered drugs. New rules like step therapy requirements have also been implemented, potentially making it harder for patients to access drugs their doctors recommend.It's important for seniors to understand these changes and their potential impacts on drug access before Medicare's open enrollment period begins in October.  Contact Carleen Lachman, Independent Insurance Specialist at 724-571-4688 to learn more.